HYPERTHYROIDISM

MODE OF OPHTHALMIC MANIFESTATIONS

Abstract

Objective: Thyroid eye disease presents a special challenge to the ophthalmologists with
pathogenetic enigma & therapeutic dilemma. The objective of the study is to determine the frequency of mode of
ophthalmic manifestation of thyrotoxicosis, rating of all components of “NOSPECS” classification system and to
determine the relative magnitude of low & high index orbitopathies. Design: Cross sectional study. Setting: The
department of ophthalmology Allied Hospital / Punjab Medical College (PMC) & Punjab Institute of Nuclear medicine
(PINUM) Faisalabad. Period: From 1 Apr 2004 to 31 st st March.2005. Material & Methods: 100 patients of all age &
sex, after having diagnosed as thyrotoxic on the basis of positive laboratory investigations were subjected to a planned
ocular examination according to the given protocol. An ophthalmopathy index scoring system was adopted to tabulate
the results. Results: Among 100 thyrotoxic patients, 72 were female & 28 were male with male to female ratio 1:26.
The over all mean age was 36.59 ±13.81 years with 77 % of cases lying between 21-50 year of age. Orbitopathy was
found in 74 % of thyrotoxic patients with relative distribution of eyelid retraction 56 %, soft tissue involvement 38 %,
Proptoses 16%, restrictive myopathy 11%, corneal involvement 13 % and sight loss due to optic neuropathy 7 %. There
is more occurrence of low index orbitopathy 83 % as compared to high index orbitopathy i.e 17 %. Conclusion: The
occurrence of dysthyroid orbitopathy is not essentially present in all hyper thyroid patients. Only 3 out of 4 develop it.
The frequency of manifestation of various eye lesions in descending order is eyelid retraction, soft tissue involvement,
Proptosis, corneal involvement, myopathy & vision loss. Low index orbitopathy is more common & males are at more
risk of developing orbitopathy than females.